No abstract

With a correct diagnosis and accurate surgical techniques, positive clinical and radiological long-term results can be expected. Therefore, high tibial osteotomy may constitute an important contribution to our algorithm in the treatment of varus gonarthrosis.

Magnetic resonance imaging (MRI) is highly sensitive and specific for the diagnosis of spondylitis and in that respect is superior to other radiologic methods. Its excellent morphological resolution allows early recognition of pathologies and spread of the spondylitis. Affected vertebral bodies and discs reveal typical alterations in T1- and T2-weighted images; post-gadolinium images are necessary to improve specificity. MRI helps to diagnose tumors and degenerative changes. Thus, MRI is the method of first choice in the diagnosis and surveillance of spondylitis and spondylodiscitis.

No abstract

In this retrospective cross-sectional study, we contacted patients who had been diagnosed with (and, if necessary, treated for) knee cartilage defects by arthroscopy at one of seven treatment centres in Germany between 1997 and 2001. In early 2003, patients completed a questionnaire on the health care resources they had used since the time of the arthroscopy. Based on this information, we determined follow-up costs. Data from a total of 1,708 patients were included in the final analysis. Of these, 1,070 were assigned to the initial operation (IO) group (61% men, 49+/-15 years; 39% women, 52+/-14 years) and 638 were assigned to the re-operation (RO) group (64% men, 44+/-13 years; 36% women, 47+/-14 years). The cumulative direct medical costs caused by knee complaints for the first 5 years following the arthroscopy were 1,984 Euro for the IO population and 4,203 Euro for the RO population. The cumulative indirect costs (i.e. costs associated with loss of productivity), however, amounted to 7,669 Euro and 15,265 Euro, respectively, and were thus almost four times as high as the cumulative direct costs. This is the first study that quantifies the considerable follow-up costs in patients who have undergone surgery for knee cartilage defects. As such, it may provide a yardstick for future treatments.

Malfunction of the infraspinatus muscle and teres minor muscle illustrate the typical clinical picture in patients with brachial plexus palsy. The arm hangs down in an inwardly rotated position and elbow flexion is hindered by striking of the lower arm against the thorax. Between 1995 and 2000, we have done external rotational osteotomy of the humerus for nine patients with brachial plexus palsy. The mean age of the patients at the time of operation was 29 years (range 15 to 42). The mean follow-up time was 24 (6 to 69) months. Preoperatively, the patients all had appreciable deficits of external rotation (mean deficit 37 degrees, range 10 degrees to 70 degrees). As a result of osteotomy, external rotation was improved in all patients, the mean increase being 42 degrees (range 25 degrees to 60 degrees). All patients were subjectively content with the improved position of the arm and its function. They were able to move their hands to their faces without striking the lower arm against the chest on elbow flexion, or without compensatory evasive movement of the shoulder.

An augmented anterior instrumentation may provide similar stability for bony fusion as does the posterior instrumentation.

High tibial osteotomy in the varus knee has been successfully performed for a long time. Several newer operation techniques have been established in recent years. We tested the primary stability of several of these techniques in vitro. Ten human cadaveric fresh-frozen specimens were used that had a mean age of 54 years (range 29-72 years) and a weight of 55-85 kg. All specimens were harvested, frozen, and subsequently thawed under the same conditions before testing. The following implants were tested: one-third tubular plate with a cortical screw (AO, Synthes), blade plate with screws (Giebel's plate, Link), bone staples (osteotomy staples, Krackow staples, Smith & Nephew) and an external fixator (Orthofix). The specimens were mounted in metal cylinders and then loaded in two different setups: transverse forces were applied to the osteotomy site by hanging weights parallel to the osteotomy plane in a static-loading frame, and axial forces were applied by a materials testing machine (Zwick). Displacement was recorded using a linear variable displacement transducer (LVDT). The highest stability was achieved by the external fixator and the bone staples. Giebel's blade plate and the one-third tubular plate were less stable. Retention of an intact medial cortex was a decisive factor in obtaining primary stability. We found that the primary stability of the tested devices was generally comparable as long as they were correctly implanted. It was also noted that lateral spacing of the osteotomized bone should not exceed 3 mm. If the medial cortex is transected intraoperatively in lateral osteosynthesis, an additional medial implant is necessary to ensure sufficient primary stability. For practical reasons it was necessary to neglect the contribution of the soft tissues around the knee, although all implants were tested under the same conditions. Care should thus be taken when interpreting the results of this study in a clinical setting.